Managing Panic Attacks

What is a Panic Attack?

A Panic Attack is like a takeover or hijacking of your whole body by feelings of alarm. The takeover is physical, mental and emotional. In the worst case you may fear dying from suffocation or heart attack.

The physical effects are due to adrenaline flooding the body – which can make you feel nauseous, bringing on a cold- or hot-sweat, cause palpitations, make you gasp for breath, make you very tense and headachey. Mentally you may become more alert but if the takeover is really strong, you will become jumbled and confused, repetitive like you’re speaking in a loop. The whole can feel like a physical and/or mental collapse. Emotionally you may feel helpless, restless, rooted to the spot, numb, withdrawn, fearful.

The symptoms of a panic attach are themselves intensely scary and can create more panic, so creating a vicious cycle.

Why do I have them?

You panic because something around you feels threatening and your natural alarm response has been triggered. The reaction is supposed to channel all your energy to meet the threat, closing down all other bodily functions, which is why you feel ill. If there is a real threat there, it enables you to fight or run away. You may have heard this referred to as the “Fight or Flight” response, although a more accurate name is “Fight, Flight or Freeze” because a common natural response to threat is to freeze up.

If there seems to be nothing really threatening around, then this means you have become hyper-aroused. That is, historical events have made you over-sensitive to threats, so you get a massive response to a small threat. The threat is still there – you aren’t reacting for nothing – but it isn’t as big a threat as the reaction suggests. So the panic attack may seem to be coming from nowhere.


That’s the term for a state of being where you are on-alert all the time. You are always expecting something threatening and so can never truly relax. This is a learned response, which may well be based on events in childhood, though it can also be learned in adulthood. It is caused by repeated feelings of threat with no chance to recover or process the feeling. So each episode adds to the distress of the last. You learn to be on guard.

What can I do about panic attacks?

There are two parts to managing panic attacks, a short-term coping strategy and a long-term stress-reduction strategy.

Short term: Breathe!

The key to managing a panic attack is to breathe. You may be breathing already, but too fast – hyper-ventilating – which is making things worse. What I mean is you need to breathe properly.

This means belly breathing, not chest breathing.

Let your upper body relax, drop your shoulders, relax any tension in your upper back. Let all the air in your lungs just flow out without force, just by letting yourself deflate. Then breathe in slowly as if you are just opening your mouth to let air flow in, letting it inflate your belly, while not moving your chest much at all.

It can help to place one hand on your chest and one on your belly to make yourself aware of what you’re really doing. The hand on your chest should hardly rise at all, whilst the hand on your belly moves a long way.

The best position for this is sitting down, feet firmly planted with your legs apart, leaning forward with your arms resting on your legs, taking a bit of your weight. This position encourages belly breathing.

You don’t have to try, it is after all a natural process, but resist any temptation to force breath by using your chest or shoulders – keep them relaxed. You have probably been taught to breathe wrongly in the past – we are taught to keep our bellies in and invisible, shoulders back, breathing with the ribs and upper chest. It will take practice to undo this erroneous teaching.

Its a good idea to practice this when you are not having a panic attack so that it is already familiar when you do have a panic attack.

That’s the physical side, but there is also a mental and emotional side. Mentally, tell yourself that by breathing properly you are taking control, that you can control the panic attack. Self-criticism is not helpful here, kicking yourself for having a panic attack will make it worse, so use a reassuring inner voice, be kind to yourself, so this then feeds an emotional sense of reassurance that reduces the distress and the panic.

Long-term: stress reduction and taking control

Panic attacks are less likely to happen if you reduce your overall stress levels, calming yourself down from a hyper-aroused state. It also seems that assertiveness helps – since the antidote to the helplessness of a panic attack is to take control.

With stress-reduction you need to work out what’s right for you – one person’s stress reduction is another person’s stress creation!

It helps to have some idea of what is triggering your panic attacks. For example, if you have had a terrifying experience in the past, then anything that feels even a bit like that experience will trigger you. Or, if you experienced abusive behaviour in the past, a particular behaviour that feels even a bit similar may trigger you, again because of an association with a past event or series of events. Or a phobia may be a trigger. Sometimes you cannot work out what the trigger is, in which case trust that there is one, but maybe it’s obscure and may take time to identify. It will be there, it always is.

Don’t dismiss the underlying meaning of a panic attack, it may be alerting you to a real danger that you need to get away from. An abusive person triggering memories of earlier abuse is an example – you really do need to escape in this case.

However, it may be that you are being triggered by an association which is not itself a present danger – a smell, a taste, a colour, a phrase, a tone of voice.

In all cases you can help yourself by reducing your hyper-aroused state so that the triggers happen less often. It seems that the only real way to improve is to spend time being calm, relaxing, having quality me-time. This allows the body to come down from the hyper-aroused state and recover from it.

Find your own relaxation strategy: breathing exercises, yoga, listening to music, meditation, exercise, especially walking, whatever works for you and makes you feel completely safe and relaxed. Think about where to do it too – it must be a place that feels safe and secure – homely. If you need to lock the doors, close the curtains, hide from the world, then just do it. It doesn’t matter that other people don’t seem to need this, you do.

Getting Support

Why not join a support group? It helps to know you’re not alone and that others have similar experiences to you.

Let family and friends know what helps if you have a panic attack and ask them to help you by reminding you what you need to do to take control.

Finally, counselling can help with this. In counselling you can understand your particular triggers, make sense of those triggers in terms of your personal history, find strategies that work in dealing with panic attacks, and also find strategies for stress reduction.